School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.).
Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing.
Stroke. 2024 Sep;55(9):2212-2220. doi: 10.1161/STROKEAHA.124.046597. Epub 2024 Jul 17.
Upper extremity (UE) motor function impairment is a major poststroke complication whose recovery remains one of the most challenging tasks in neurological rehabilitation. This study examined the efficacy and safety of the personalized neuroimaging-guided high-dose theta-burst stimulation (TBS) for poststroke UE motor function recovery.
Patients after stroke with UE motor impairment from a China rehabilitation center were randomly assigned to receive high-dose intermittent TBS (iTBS) to ipsilesional UE sensorimotor network, continuous TBS (cTBS) to contralesional UE sensorimotor network, or sham stimulation, along with conventional therapy for 3 weeks. The primary outcome was the score changes on the Fugl-Meyer assessment-UE from baseline to 1 and 3 weeks. The secondary outcomes included the response rate on Fugl-Meyer assessment-UE scores posttreatment (≥9-point improvement) and score changes in multidimensional scales measuring UE, lower extremity, and activities and participation.
From June 2021 to June 2022, 45 participants were randomized and 43 were analyzed. The iTBS and continuous TBS groups showed significantly greater improvement in Fugl-Meyer assessment-UE (mean improvement, iTBS: 10.73 points; continuous TBS: 10.79 points) than the sham group (2.43 points) and exhibited significantly greater response rates on Fugl-Meyer assessment-UE (iTBS, 60.0%; continuous TBS, 64.3%) than the sham group (0.0%). The active groups consistently exhibited superior improvement on the other 2 UE assessments at week 3. However, only the iTBS group showed greater efficacy on 1 lower extremity assessment than the sham group at week 3. Both active groups showed significant improvements in activities and participation assessments.
The study provides evidence for the efficacy and safety of high-dose TBS in facilitating poststroke UE rehabilitation.
URL: www.chictr.org.cn; Unique identifier: ChiCTR2100047340.
上肢运动功能障碍是脑卒中后的主要并发症之一，其恢复仍然是神经康复中最具挑战性的任务之一。本研究探讨了个性化神经影像学引导下高剂量经颅磁刺激（TBS）治疗脑卒中后上肢运动功能恢复的疗效和安全性。
来自中国康复中心的脑卒中后上肢运动功能障碍患者被随机分配接受高剂量间歇性 TBS（iTBS）治疗患侧上肢感觉运动网络、连续 TBS（cTBS）治疗对侧上肢感觉运动网络或假刺激，同时接受常规治疗 3 周。主要结局是 Fugl-Meyer 上肢评估（FMA-UE）评分从基线到 1 周和 3 周的变化。次要结局包括治疗后 Fugl-Meyer 上肢评估（FMA-UE）评分的反应率（≥9 分改善）和多维量表测量上肢、下肢和活动及参与的评分变化。
2021 年 6 月至 2022 年 6 月，共 45 名患者被随机分配，43 名患者进行了分析。iTBS 和 cTBS 组 Fugl-Meyer 上肢评估（FMA-UE）评分的改善明显大于假刺激组（平均改善，iTBS：10.73 分；cTBS：10.79 分），且 Fugl-Meyer 上肢评估（FMA-UE）的反应率明显高于假刺激组（iTBS，60.0%；cTBS，64.3%）。活性组在第 3 周时在另外 2 项上肢评估中始终表现出更好的改善。然而，只有 iTBS 组在第 3 周时在 1 项下肢评估中比假刺激组显示出更大的疗效。两个活性组在活动和参与评估中均显示出显著改善。
该研究为高剂量 TBS 促进脑卒中后上肢康复的疗效和安全性提供了证据。
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